Association between hematoma expansion and short-term neurological outcomes in patients with spontaneous basal ganglia intracerebral hemorrhage at different blood pressure levels after blood pressure control: a single-center retrospective study.

OBJECTIVE: To evaluate whether achieving a lower post-treatment systolic blood pressure (SBP) range during the acute phase was associated with reduced hematoma expansion and improved short-term neurological recovery in patients with spontaneous basal ganglia intracerebral hemorrhage (ICH). METHODS: In this single-center retrospective study, 228 patients with spontaneous basal ganglia hemorrhage were analyzed after all had been managed under the same institutional early blood pressure (BP)-lowering protocol. For post hoc analysis, patients were retrospectively classified according to their achieved post-treatment SBP levels during the first 24 h into a lower achieved SBP group (120-140 mmHg) and a higher achieved SBP group (140-160 mmHg), rather than into prospectively assigned intensive vs. conventional treatment groups. Because group assignment reflected achieved BP levels rather than randomized treatment allocation, multivariable adjustment was performed to reduce confounding, although residual confounding and the limitations of complete-case analysis could not be fully excluded. The primary outcome was hematoma expansion (>6 ml or >33% increase on follow-up CT at 24-48 h). Secondary outcomes included absolute hematoma growth, neurological improvement (change in NIHSS score from admission to discharge), functional outcome at discharge (mRS), in-hospital mortality, hospital and ICU length of stay, and predefined safety endpoints. RESULTS: The lower achieved SBP group had lower hematoma expansion rates (5.4% vs. 10.3%, P = 0.04) and less absolute hematoma growth [3.1 (IQR 1.2-5.0) ml vs. 9.4 (IQR 5.2-14.8) ml, P < 0.01]. The lower achieved SBP group demonstrated superior neurological recovery, with significantly greater NIHSS improvement (P < 0.05) and higher rates of favorable functional outcomes (mRS 0-2, P < 0.05). BP control was also more rapid and stable in the lower achieved SBP group, with reduced variability and longer maintenance within the target range. Multivariable analysis showed that belonging to the lower achieved SBP group was independently associated with a reduced risk of hematoma expansion (adjusted OR 0.52, 95% CI 0.30-0.90). Safety profiles were comparable, with no significant difference in serious adverse events. CONCLUSION: In this retrospective cohort, achieving a lower post-treatment SBP range during the first 24 h was associated with less hematoma expansion and better short-term neurological recovery in spontaneous basal ganglia hemorrhage.